Weiner D A, Ryan T J, McCabe C H, Kennedy J W, Schloss M, Tristani F, Chaitman B R, Fisher L D
N Engl J Med. 1979 Aug 2;301(5):230-5. doi: 10.1056/NEJM197908023010502.
To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary-artery disease, we correlated the description of chest pain, the result of stress testing and the results of coronary arteriography in 1465 men and 580 women from a multicentered clinical trial. The pre-test risk (prevalence of coronary-artery disease) varied from 7 to 87 per cent, depending on sex and classification of chest pain. A positive stress test increased the pre-test risk by only 6 to 20 per cent, whereas a negative test decreased the risk by only 2 to 28 per cent. Aothough the percentage of false-positive results differed between men and women (12 +/- 1 per cent versus 53 +/- 3 per cent P less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary-artery disease. We conclude that the ability of stress testing to predict coronary-artery disease is limited in a heterogeneous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient.
为了确定冠状动脉疾病的患病率在多大程度上影响负荷试验的诊断准确性，我们将来自一项多中心临床试验的1465名男性和580名女性的胸痛描述、负荷试验结果以及冠状动脉造影结果进行了关联分析。根据性别和胸痛分类，试验前风险（冠状动脉疾病患病率）从7%到87%不等。负荷试验结果呈阳性仅使试验前风险增加6%至20%，而结果呈阴性仅使风险降低2%至28%。虽然男性和女性的假阳性结果百分比有所不同（分别为12±1%和53±3%，P<0.001），但在冠状动脉疾病患病率匹配的亚组中未观察到这种差异。我们得出结论，在一个异质性人群中，负荷试验预测冠状动脉疾病的能力有限，在该人群中，疾病患病率可通过胸痛分类和患者性别进行估计。
